Gompers

http://www.amazon.com/Saul-Rosemary-Kay/dp/0312253338/ref=sr_1_10?ie=UTF8&s=books&qid=1207065958&sr=8-10 http://www.amazon.com/BABY-ER-Doctors-Medicines-Miracles/dp/B000H2MGXU/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1207065925&sr=8-1 Baby ER is usually found in regular public libraries and major bookstores. Saul I ordered online years ago and have never seen it around here as it was published in Britain.

We must be the only ones that never re-use med tubing. They do it in the PICU but we don't in the NICU here. We use fresh tubing every single time and disconnect it after the med is done infusing. Our IV tubing for fluids and drips is changed every 96 hours, except for lipids which gets a new bag and new tubing every 24 hours. If it's something factory-made, like heparinized saline or plain D10W, we can leave the same bag and tubing running for 96 hours. If it's made by the pharmacy, like hyperal or drips, a new bag is spiked or a new syringe is hung each day, but using the same tubing for 96 hours.

I read that book a few years ago. Wasn't that the one where there were several cases discussed and there were all the doc's opinions about what to do with each baby's care? Am I thinking of the right book? It showed how we literally play God in deciding who lives and dies in the NICU. I think there were a couple of kids with hydrocephalus, and I thought there was one family that didn't even want to feed their baby, wanted to let him die, but really he had a decent prognosis and it was very unethical to stop feeds. Meanwhile there was a different baby with hydro who had a horrible prognosis yet the parents wanted everything done and the docs felt it was unethical to do so. Is that the right book? Another good one is "Baby ER" which is a nice thing to give to family and friends of ours who really don't "get" what happens in the NICU, what we do every day. The ones who think that we just feed babies all day long...or the ones who think all our babies die. A great book for new NICU nurses to read is "Saul" by Rosemary Kay. It's the story of a 23-weeker written by his mother...from his point of view. Gives a totally different perspective and really makes you THINK about what these babies are going through. I've read it a lot and cry my eyes out every time!

You hit the nail on the head.

I dare ANYONE to watch that video and not cry. I think it was the father's voice, especially when he said how proud he was...

We wrap the baby in hospital blankets and then put them in the infant body bag. Two nurses go down to the morgue together, for support, and security meets us down there to open the room. We also have a shelf that we place the infants on. I wish they had something else, but I also know it's just a holding area. If it's night shift, we'll often just carry the baby downstairs. But if it's during the day or evening when there are visitors in the hospital, we place the baby in the drawer of a basinette and take them down that way. I know it might seem cold, but we are thinking of the visitors. And we kind of say our goodbyes when wrapping the baby up after the bath, I think that kind of helps us. It's much harder to say goodbye at the door to the morgue. I used to work at a children's hospital and they had a fake book cart with drawers underneath where they'd place a deceased child. Again, many may think that is very cold, but remember this is a hospital full of wandering children and we need to protect them from trauma. Gosh knows they are traumatized enough just being at the hospital.

We've all said it before, and I'll be the first to say it again... Why do the nicest parents always have the sickest kids??? It's just not fair. What a wonderful family that little boy had, to cherish his short life and accept him for what he was instead of trying to "fix" him like so many others do? I hope that they are blessed with many healthy children in the future. Thanks so much for the link. I always love a good cry!

We swab every baby on admission and then every baby gets swabbed every other Tuesday for their entire stay. I believe the entire hospital is now doing this as well now. I do have to say that for all the MRSA-postitive babies we've had, I've never once seen any of them actually SICK from MRSA. They are just colonized with it and stay in isolation until discharge. We used Bactroban one time and it did work - baby was negative after one week - but I don't know why we don't use it anymore.

Same here - we are not allowed to place the baby in the seat or help with installation at all. We can do our corificeat test, sure, but that's usually a few days before discharge. When the kids are actually going home, it's up to the parents. We can tell them things but can't physically get in there and do it. We cover car seat safety in our optional infant care class, and we also have a video for parents to watch if they wish. It drives me absolutely batty to see corificeats on our unit with the bases attached - you don't need the base to do the corificeat test, there is a line or an actual level on all infant seats that shows you what angle it needs to be at, plus the base is purely for parental convenience, not safety. We tell the parents to take the base HOME and have it installed properly in their cars, but few listen. Many times a discharge is held up because Dad is outside trying to get the base attached. It's amazing to me how confusing some of these seats and bases can be when it comes to both installation and infant strap adjustment!!! The seat we got for our daughter took one minute to install properly in the car and the restraint straps couldn't be easier to adjust. I can see, though, looking at some of these other seats, why so many are installed and used improperly!!! The only seats we lend out are car beds for kids who fail their corificeat test or have another medical reason for not sitting upright in a corificeat. These kids are almost always followed by our unit's home care team, so we tend to get the seats back! I don't think that we're being mean when we say it's the parents' problem to get the seats installed. We are not certified to install them so telling the parents that they need to make arrangements for installation isn't out of line, I don't think. If they were in the regular newborn nursery it wouldn't be any different. If a pregnant woman goes to any prenatal classes, reads pregnancy magazines, registers at a baby store, or talks to other people with kids, they should be well aware that they need to install the corificeat BEFORE the baby is born. While it would be nice to have nurses certified in car seat installation, the classes are very expensive and I believe one week long, 9-5, and most units aren't going to pay for a bunch of nurses to go through that. It would be hard to make sure one of those nurses is working every single shift, too, and we all know that kids can go home at 2am sometimes!

Tiffy, if I didn't know better I'd swear we work on the same unit! I absolutely HATE reticulocytes, let me tell you!!! I don't care that the baby is retic-ing! The crit is 23 now and it's going to take MONTHS for this preemie to get it up where it needs to be. So basically that baby is going to be exhausted for months. It's such a shame.

I have missed this board so much and now I remember why! You are all too sweet. Good to be back!!!

Glad you had a good experience, Bryan! I *thought* that I wanted to do NICU nursing from the start - it's why I went to nursing school. But there was always some doubt in my mind that it would be nothing like I expected. Then in my junior year of nursing school I got to do an observation day in the NICU at a teaching hospital. Oh my gosh!!! It was, like you said, the best clinical day EVER!!! It just felt like *home* as corny as that sounds. I was just like, "Yep, this is it. My gut was right!" Went on to work as a nursing assistant in a NICU my senior year, then did my senior role transition in another NICU, and a few months later I started in the unit where I've been now for nearly ten years. Never looked back. It is so wonderful when you find your niche, isn't it? It just hits you like a ton of bricks!

Our travelers and agency nurses are treated about the same - before they can come to our unit they have to go through a 2-day hospital orientation which includes classes on computer charting. If it's a traveler we'll do 2-3 shifts of orientation - one with a feeder-grower assignment, one with a regular assignment (stable vent and a level II type kid, for example), and then one with a sicker baby. That way they learn who to call, where to go for what, and how our general routine goes. Agency nurses don't get any orientation - we put them with the feeder-growers from the beginning. If they come to us a lot, and there are a few who have become like staff members, they can ask for sicker babies and more responsibility. But we would never throw either a traveler or an agency nurse into a dangerous assignment!!! Why would we do that to our babies? Just for spite? I know some units give their travelers and agency nurses horrible assignments, saying they have to "earn all that big money" they make and such. We would never do that because it puts our patients at risk. If anything our travelers and agency nurses get BORED because they get all the feeder growers and chronics. But if we get to know them and are comfortable in their skills, we'll give them sicker and sicker kids. But we'd never give them admits or anything like that. We're all there to take care of the babies as best we can. I hate when politics gets in the way.

Thanks for the thanks! By the way, your signature line is one of my favorite quotes ever.

I agree with littlepeach and kitty29 - many of us who have been in the NICU for years will tell you the same thing: When losing a baby doesn't upset you anymore, that's when you know your time in the NICU is up. If we didn't care so much for these babies and their families, we wouldn't be doing this. Most people, nurses or not, will say to you "I don't know how you can do that" upon finding out that you're a NICU nurse. To us, we couldn't imagine doing anything else! But to them, we have the saddest job in the world. And sometimes, it is the saddest. There will be times in your NICU career where you will drive home from work sobbing so hard you can barely see the road. But you will drive right back to work for your next shift. Are we gluttons for punishment? NO! We just know that not every day will be that bad, that not every baby will have the same fate. That's what keeps us going. And yes, we will get attached, again and again, no matter how hard we try not to. It's impossible NOT to get attached sometimes. We are the ones caring for these tiny babies and often find ourselves smack dab in the middle of these families' most intimate moments. There will be times you hand a baby to his mother to hold for the very first time...or for the very last time. You will cry tears of joy with families as their babies finally go home...or tears of pain as they say goodbye to them. Of course it's going to affect us. If we weren't sensitive, compassionate people, we probably wouldn't be NICU nurses in the first place. ((( HUGS ))) to Silkiebyrd - did you ever finish those blankets?

That is hysterical! We're really slow right now too - also have about 20 babies when we usually have 40. Glad to know it's slow other places than here! Of course, whenever we say "Man we need some babies!" the non-NICU people in our lives look at us like we're insane. We don't WANT to have more babies sick, but it's hard to explain that to people who have horrified looks on their faces...

I'll have to check what brand we use, but some of our bigger, sicker kids (usually PPHN or post-op) have gotten double lumen lines recently. We use one lumen for TPN, Fentanyl drips, pressors, etc. The other lumen we run 0.9%NS with heparin and use it for everything else except I do believe they're too small for blood products. One tip - we've found that since the lumen is so small, that if fluids are running at our normal TKO rate of 0.5 cc/hr they tend to clot off! Once we started running them at a minimum of 1 cc/hr we've had better luck.

Hey everybody!!! I'm still alive, just extremely busy with life these days. Having a 6-month-old plus working full time, yikes!!! Miss you all though! Anyway, when I logged on to Comcast today, I saw a story about a gorilla baby that was abandoned by her mother in a German zoo, and she was taken to a NICU and treated for hypothermia and dehydration. They said that because human and primate babies are so similar, it wasn't really a problem to treat the animal. And thinking about it, I would actually LOVE to have been the admit nurse!!! My hospital is located near a zoo, and they once had a chimp baby that was septic - infection started at the umbilicus - so one of our NNPs went there and placed a PICC line in him for long-term antibiotics. She said it was just like treating a hairy NICU baby, nothing much else was different. http://www.comcast.net/news/index.jsp?cat=GENERAL&fn=/2007/07/03/705817.html&cvqh=itn_gorilla

Our babies are all swabbed on admission and then again every two weeks. If a baby comes up positive, he or she is cohorted. Nurses caring for MRSA babies are cohorted as well during that shift. If the baby is one of twins/triplets/etc. then we cohort the whole family because the parents will be touching all the babies. We gown and glove for contact with MRSA patients, same goes for the parents. We even gown and glove if we're at the bedside charting and not touching the baby. Only used Bactroban once and wonder why we haven't since...right now we cohort kids from the day they swab positive until the day they're discharged.

My thoughts are with this family, but I also hope that this serves as a wake-up call to both fertility docs and couples seeking infertility treatments. A singleton has such a poor chance for survival even at 23-24 weeks. I just can't see how any of these poor babies will survive. I hope that the remaining babies are doing well, for the sake of this family.

I use a steam warmer for my own baby's bottle at home and find it to be a bit off sometimes. You pour in water - more or less depending on how much milk there is to heat - and the metal base heats up to steam the water until it's completely evaporated. The bottle heats while it sits in the steam. We've been through two of them already and both had issues with bottles being over or underheated at times. At work, each baby has it's own plastic jug - the same kind used for ice water in adult areas, just without the lid - and we just fill those with warm water to heat the bottles. They are labeled and kept at each baby's bedside, then disposed of when the baby is discharged. We dry them out upside down on a washcloth in between feedings. We also place each bottle or syringe of milk inside of a glove when placing it in the water to keep any water-borne germs away. We use these jugs for both thawing out breastmilk and heating up feedings. We heat them because it's easier to digest if it's warm - especially important for preemies and babies with reflux. I was once told by a GI doc that food has to reach body temperature before it's able to leave the stomach - so makes sense to heat it a bit!

Okay, that new video footage is just as bad! Mom was talking about how this baby is going to be a runner or a ballet dancer, because since she was born her tiny little legs have never ever stopped moving. That's really the result of a premature and possibly damaged central nervous system. Glad to see Dad is involved, though, because she'll need support at home.

Swaddling the baby is helpful, just keep the one extremity you're sticking out and wrap that baby up nice and tight! Pacifiers and sucrose water work wonders, as stated previously. We use #24 gauge catheters for all our neonates. Definitely use a pretty flat angle as the vessels are very superficial usually. Rarely draw off an IV - it'll usually ruin the vein for us. We'll do arterial punctures instead for labs. We make our own flushes - we'll use the skinny 1cc tuberculin syringes, fill them with NS, and use them to flush the catheter if we get blood return. Tegaderm the actual site - babies are active and tape sometimes comes loose at the site. Arm boards are a necessity - make sure to splint the extremity right where the catheter is - many times I've seen IV's go bad because the board wasn't right where the IV was and the catheter would keep bending with the baby's movements.

$14.99 for a 3-pack at Babies R Us, I just bought some for my daughter yesterday.

Good Morning America had a feature about a "miracle" baby that just went home from the hospital. She was 15 ounces and is now TWO YEARS OLD and finally going home. She is trached, vented, and appears to be severely developmentally delayed. The thing that bothers me is that they're very excited to show this baby at home and the mom is talking about how WRONG the doctors were that told her the baby would never live, etc. They're calling her a miracle and going on and on about how wonderful it is. I just don't think this is the kind of thing I'd call a miracle. I mean, it does give a more realistic view about what saving a micropreemie means sometimes compared to those true miracle babies that were 300 grams and are now doing absolutely fine. But something about this news story just really really bothers me. Anyone else??? http://video.aol.com/video/tiny-baby-comes-home/1901089 (If the video doesn't come up, type "miracle baby" in the search box and it'll be the first video - don't know why the link doesn't always work...)